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Title: Clearance of Piperacillin-Tazobactam and Vancomycin During Continuous Renal Replacement With Regional Citrate Anticoagulation.
Austin Authors: Sharrock, Lucy;Ankravs, Melissa J;Deane, Adam M;Rechnitzer, Thomas;Wallis, Steven C;Roberts, Jason A;Bellomo, Rinaldo 
Affiliation: Division of Anaesthesiology, Critical Care, Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France..
University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia..
Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia..
Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia..
The University of Melbourne, Melbourne Medical School, Department of Critical Care, Royal Melbourne Hospital, Parkville, Victoria, Australia..
Intensive Care
Pharmacy Department, Royal Melbourne Hospital, Parkville, Victoria, Australia..
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia..
Issue Date: 1-Apr-2023 2022
Publication information: Therapeutic Drug Monitoring 2023; 45(2)
Abstract: The use of regional citrate anticoagulation during continuous veno-venous haemodiafiltration (CVVHDF) has increased worldwide. However, data on its effect on the pharmacokinetics of antibiotics are limited. In this study, the authors aimed to measure the clearance of piperacillin-tazobactam and vancomycin in patients receiving CVVHDF with regional citrate anticoagulation. This study measured piperacillin-tazobactam and vancomycin concentrations in patients receiving CVVHDF with regional citrate anticoagulation. Dosing regimens were independently selected by intensivists. Arterial blood and effluent fluid samples were obtained over a single dosing interval and analyzed using ultra-high-performance liquid chromatography with tandem mass spectrometry. Seventeen sampling intervals in 15 patients (9 receiving piperacillin-tazobactam only, 4 receiving vancomycin only, and 2 receiving both) were used. The median overall clearance for piperacillin was 35.2 mL/min (IQR: 32.2-38.6), 70 mL/min (IQR: 62.7-76.2) for tazobactam, and 29.5 mL/min (IQR: 26.2-32) for vancomycin. This is the first study to quantify the pharmacokinetics of vancomycin and piperacillin-tazobactam in patients receiving CVVHDF with regional citrate anticoagulation. These results indicate high clearance and provide key information to guide optimal dosing.
DOI: 10.1097/FTD.0000000000001028
ORCID: 0000-0002-1650-8939
Journal: Therapeutic Drug Monitoring
PubMed URL: 35994070
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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